Development of a multicomponent survey of experiences of tragedy-based and fear-based trauma in COVID-19 healthcare professionals.

Background: Life confronts us with many aversive events, including injuries, diseases, losses, decay and death. These life realities often stimulate compassion motives orientated to try to alleviate and prevent suffering. While concepts of 'stress' and 'fear' have dominated the discourse on responses to 'traumatic events', a less common narrative is that of 'tragedy'. Tragedy narratives focus on the empathic sensitivities to the 'suffering and traumas of life' and hence are related to compassion motives. Tragedy has a long history with complex meanings and is focused on sadness and loss, rather than fear. Hence, it invites a different language of experiences requiring grief work rather than (just) fear exposure work. While the experiences of healthcare professionals (HCPs) working with COVID-19 patients have been studied regarding stresses and fear-based traumas, HCPs were also witness to, and experienced these traumas, in terms of tragedy. This study developed a multicomponent survey to explore different dimensions and patterns of HCPs' experiences with a focus on issues of sadness, grief and tragedy. Focusing on the Methods: From informal discussions with colleagues working in high impact COVID-19 environments, such as intensive care units, and with psychologists who supported those staff, we identified a non-exclusive and non-exhaustive set of themes that textured their experience. We were particularly interested in experiences that could be seen as descriptions of tragedy-based trauma. These were presented as novel self-report surveys to HCPs in British and Portuguese samples. This sought to explore diverse patterns of experiences and responses beyond diagnostic criteria like posttraumatic stress disorder (PTSD). Measures of social safeness, trauma, posttraumatic growth and burnout were also given to explore these themes using standard scales. Results: Our survey suggested key compassion themes of: high levels of empathic distress for the suffering of others and being more fearful of passing the virus to friends and close others than being infected oneself. As suggested by a tragedy focus, sadness and tearfulness were as prevalent as fear. The compassionate support of others, i.e., family, friends and colleagues, were central for coping. Reflecting on how they had changed over time, many HCPs noted personal growth. In terms of their emotions, the strongest ones HCPs wanted help with were 'finding joy', indicating perhaps that loss of textures of positive affect can be a consequence of these events, as in 'sadder but wiser' sentiments. These data indicate that the impacts of these types of events are richly textured and extend beyond issues of threat and PTSD symptom-focused approaches. It invites clinicians to explore and contextualise some trauma experiences as tragedy, which facilitates a different languaging and processing of such events. Conclusion: The way we use language and narrate traumatic events can have a major impact on how we come to process and make sense of them, and how we can help people going through these experiences. This paper suggests that narrating certain types of loss-based trauma events, particularly those linked to health and death (as in COVID-19) can be regarded as forms of human tragedy, which links to more ancient ways of addressing life's suffering, including the importance of shared compassion and communal grieving. This is an initial exploration of potential experiences of HCPs that can distinguish concepts of tragedy-based trauma from fear-based trauma. Clarity on these variations can offer opportunities for new insights into sources of distress, and therapeutic interventions.